Bei der Rekonstruktion des durch Krankheit oder Trauma geschädigten Hüftgelenkes hat sich der Ersatz des Gelenkes durch eine totale Endoprothese heute allgemein durchgesetzt. Dabei hat unter Beachtung einer differenzierten Indikationsstellung sowohl die zementierte als auch die zementfreie Technik ihre Anwendungsberechtigung. Das Problem der dauerhaften Verankerung der zementfreien Hüftendoprothese ist jedoch trotz ständiger Weiterentwicklung von Operationstechnik, Implantatdesign und Werkstoffen bis heute nicht abschließend gelöst. Die häufigste Versagensursache ist dabei die aseptische Schaftlockerung, die mit Veränderungen des knöchernen Lagers einhergeht. Mit der Osteodensitometrie existiert eine Technik, die eine schnelle, nichtinvasive und quantitative Beurteilung der Knochenmasse erlaubt. In der vorliegenden Querschnittsstudie wurden 95 Zweymüller-Schaftimplantate zwei, vier bzw. sechs Jahre nach Implantation untersucht. Dabei wurden die Ergebnisse der klinischen Untersuchung und der konventionellen a.p. Röntgenaufnahme den mit Hilfe der DEXA-Technik ermittelten Knochendichteänderungen am Femur gegenübergestellt. Der Vergleich von Knochendichteänderungen in einzelnen Femurabschnitten in Abhängigkeit von der Implantationsdauer läßt Rückschlüsse auf das Schaftdesign zu. / When hip function is several impaired by disease or trauma, total hip replacement is preferred treatment of choice today. The consideration of a differentiated position of indication justifies both - the application of the cemented as well as the cement free technique. But despite of constant further development of operation techniques, design of implantation and the used materials is the problem of a permanent embodiment of the non-cemented hip prosthesis till today not finally solved. The aseptic relaxation of the stem is the most frequent reason for failure. This is accompanied by changes of the osseous bed. With the osteodensitometry exists a technique that makes a fast, non-invasive and quantitative assessment of the bone mass possible. In this present cross-section study 95 Zweymüller-stem-implants were examined two, four and six years after the implantation. The results of the clinical examination and the results of the conventional X-ray picture were compared with the changes of the thigh femur bone density that were ascertained by the DEXA-technique. The comparison of changes of the bone density in single femur sections in dependence on the duration of the implantation allows one to draw conclusions from the design of the stem.

Made available in DSpace on 2016-01-26T12:51:22Z (GMT). No. of bitstreams: 1 fabiostuchidevito_tese.pdf: 1050230 bytes, checksum: 52d8e95acef4a4ba2f5e60d301266786 (MD5) Previous issue date: 2009-04-17 / Total hip arthroplasty is a surgery with a high success rate, providing pain relief and improvement of the articular mobility. Long-term success is related to the position and orientation of the acetabular and femoral components. Traditional preoperative planning entails radiographic analysis of the pelvis, in which a template is placed on the image, allowing an analysis of the appropriate size of the Exeter cemented prosthesis. Objective: To evaluate the effectiveness of traditional preoperative planning with the use of templating. Patients and Method: Forty-three anteroposterior X-rays were analyzed by three experienced surgeons. The evaluation of each surgeon was compared with the actual prosthesis used in the surgery and also compared with the assessment of the other two surgeons. Cohen's Kappa concordance test and weighted Kappa indexes using quadratic weighting were used for statistical analysis with a confidence interval of 95%. Results: The preoperative evaluations of Surgeons A, B and C were divided into the analysis of the sizes of the acetabular cup, stem and plug of the distal femoral canal. Surgeon A obtained a moderate agreement in relation to the acetabular component and substantial agreements in relation to the stem and plug. Surgeon B had moderate agreement in relation to both the acetabulum and the stem and substantial agreement in relation to the plug. Surgeon C obtained moderate agreement in relation to the analysis of the acetabulum and the plug and substantial agreement for the stem. The intra-observer agreement test demonstrated a prevalence of slight agreement in relation to the acetabulum and substantial agreement in relation to the stem and to the plug. Conclusion: Templating used in preoperative planning proved effective; however, there was a prevalence of slight and moderate agreement in relation to the size of the acetabular component according to the inter- and intra-observer analysis. / A artroplastia total do quadril é uma cirurgia com alto índice de sucesso, atuando no alívio da dor e melhora da mobilidade articular e seu êxito a longo prazo relaciona-se à posição e orientação do componente acetabular e femoral. O planejamento pré-operatório tradicional consiste na análise radiográfica da bacia, na qual será sobreposto um templating , o que permite a análise do tamanho adequado da prótese Exeter cimentada. Objetivo: Avaliar a eficácia do planejamento pré-operatório tradicional pelo uso do templating . Casuística e Método: Quarenta e três radiografias na posição antero-posterior e foram analisadas por três cirurgiões experientes; as avaliações de cada cirurgião foram comparadas com a prótese utilizada na cirurgia e cada resultado comparado com os resultados dos outros dois. Para avaliação, utilizou-se o teste de concordância do Capa de Cohen e do Capa ponderado, com ponderação quadrática e intervalo de confiança de 95%.Resultados: Os resultados pré-operatório encontrados pelo examinadores A, B e C foram divididos como análise do tamanho do acetábulo, haste e plug do canal femoral distal. O cirurgião A obteve em relação ao componente acetabular uma concordância moderada, e em relação à haste e ao plug uma concordância substancial. O cirurgião B apresentou resultado de concordância moderada em relação ao acetábulo e à haste e substancial em relação ao plug. O cirurgião C na análise acetabular e do plug obteve concordância moderada e substancial quanto à haste. O teste de concordância intra-observador apresentou uma prevalência da concordância leve em relação ao acetábulo e substancial em relação à haste e ao plug. Conclusão: O templating utilizado no planejamento pré-operatório mostrou-se eficaz, no entanto, em relação ao tamanho do componente acetabular houve um predomínio de concordância leve e moderada na análise inter e intraobservador.